Provider Demographics
NPI:1184034522
Name:WEBB, MARCUS (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:WEBB
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 W 20TH ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4626
Mailing Address - Country:US
Mailing Address - Phone:501-975-7456
Mailing Address - Fax:
Practice Address - Street 1:7251 W 20TH ST UNIT E
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4626
Practice Address - Country:US
Practice Address - Phone:501-975-7455
Practice Address - Fax:501-975-3631
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205103795Medicaid